Coverage Policies

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Current policies effective through April 30, 2024.

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QualChoice follows care guidelines published by MCG Health.

Clinical Practice Guidelines for Providers (PDF)

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:



Effective Date: 08/21/2003	Title: Skin Tag Removal
Revision Date: 10/01/2015	Document: BI004:00
CPT Code(s): 11200, 11201
Public Statement
*Effective Date:* a) This policy will apply to all services performed on or after the above revision date which will become the new effective date. b) For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply. Skin tags (acrochordons) are unsightly and inconvenient skin lesions with no medical importance. Their removal is considered to be cosmetic – for the convenience of the patient – rather than medically necessary. This is not a covered service.
Medical Statement
These two codes are for the removal of “skin tags or multiple fibrocutaneous tags.” Skin tags are generally small (1 to 5 millimeters in diameter – 1/25 to 1/5 of an inch) formations of normal skin with or without some small amount of subcutaneous tissue. They protrude from the surrounding skin. They have a tendency to grow to a certain size and to remain at that size. No one knows why they happen, but there may be a genetic predisposition to developing them. Many people have none. Some people have a few. An occasional person has many. It is unusual for them to appear on the face or hands. They are more common on the torso, especially in the region of the genitals and axillae (arm pits). They never turn to cancer. They occasionally become irritated. They may catch on clothes or be inconvenient to clothing, such as being in or near where elastic bands in the clothing lie. Skin tags pose no health hazard. Irritation of skin tags can be handled with Band-Aids or a change in clothing style to avoid having elastic bands rub on the skin tag. Removal of skin tags is considered to be a cosmetic procedure. These two codes are set up in Facets to deny. For removal of supranumerary digits, please see the policy on Polydactyly (BI008). Note: In the instance, in which the physician miscodes the removal of a pre-cancerous or cancerous lesion as a skin tag removal, the appeal should include a recoding of the procedure and perhaps a pathology report to document the nature of the lesion removed. There are extensive codes in the CPT book for removal of skin lesions that have some health consequences – there is never a reason a physician should use these codes for such a procedure. Codes Used In This BI: 11200 Removal of skin tags 11201 Remove skin tags add-on
Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.

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